Newborn Tests
Newborn Exam
Within a couple of hours of birth, usually after the first feeding, a head-to-toe exam is done of your baby. He or she is measured and weighed. The heart and lungs are listened to, and the baby is checked for any abnormalities from the ears and mouth, to the number of toes. Normal newborn reflexes are checked for - their absence could mean a problem with the central nervous system. Anything unusual is referred to a pediatrician. Feel free to ask questions during the exam, and to touch your baby and talk to him/her. We prefer to start when the baby is calm and are as gentle as possible, but some babies object to the necessary handling and will cry. If a pediatrician has been called to the delivery because we have a concern about the baby’s welfare, the newborn exam will be done by him/her very soon after the birth.
Eye Prophylaxis
Erythromycin, an antibiotic ointment, is routinely applied to babies’ eyes within an hour of birth. Gonorrhea and chlamydia can infect the eyes and cause blindness if untreated. They can be present with no symptoms in the mother, and lab tests occasionally have false negatives.
You may choose to have swabs done during pregnancy to look for gonorrhea and chlamydia, and be treated if either is present. Some parents choose not to expose their newborns to antibiotics.
Vitamin K
Vitamin K is important in blood clotting. It is manufactured in the intestines by bacteria. Babies need to be colonized by the bacteria from their parents and start making their own Vitamin K as soon as possible. A baby with insufficient Vitamin K may develop neonatal hemorrhagic disease - which can range from bruising with normal handling to fatal bleeding. Brain damage can result. Research shows an incidence from 1/500 to 1/1,500. Statistically, breastfed babies have a higher rate of hemorrhagic disease.
You may choose to have your baby receive Vitamin K by a single injection (IM) at the time of the newborn exam, or your baby may receive three doses of Vitamin K by mouth (PO). The first is done within a few hours of birth, the second at 4 -10 days and the third at 4 - 6 weeks. Research supports injectable Vitamin K. Oral Vitamin K appears to work, but doesn’t have extensive research to support it.
Neonatal Metabolic Screen
This is a blood test that checks for metabolic problems which could permanently damage your baby: phenylketonuria (PKU), hypothyroidism, galactosemia and MCAD. If these problems are caught early and treated your baby can avoid harm.
Phenylketonuria is an inability to metabolize a protein. Abnormal amounts build up in the body and can damage the brain. The incidence in B.C. is 1/18,000 live births. Treatment is a special diet low in phenylalinine. Your baby may be able to receive some breast milk, depending on the severity of the disease.
Hypothyroidism is an abnormally low production of thyroid hormones. These are important for normal brain development. The incidence in B.C. is 1/3,000 births. Treatment is a daily dose of thyroid medication.
Galactosemia is an inability to break down the milk sugar galactose. Galactose builds up in the body causing failure to thrive, jaundice, vomiting, diarrhea, liver damage, hypoglycemia, cataracts and mild to moderate brain damage. The incidence in B.C. is 1/25,000 newborns. It is treated by a special diet with no lactose.
Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) causes problems with fat metabolism. It can cause hypoglycemia and sudden unexpected death. It is found in 1/20,000 infants. Treatment is a special diet and supplements.
The test is done by warming the infant’s foot (to bring blood close to the surface) and then pricking the heel. Sometimes the baby must be pricked more than once to get enough. Blood is collected in four circles on blotter paper. The paper is dried and sent to a lab in Vancouver for testing. There is not an alternative test and once symptoms of these diseases are noticeable irreversible damage may have been done.
The best time to do these tests is 24 - 48 hours after the birth. A test done before 24 hours will need to be repeated. If you have an early discharge from the hospital and wish to have your midwife do the test in your home the next day you will have to sign a form saying you are deferring the test. Of course, if you have a home birth, the test will be done in your home. You can hold and comfort, or nurse, the baby while the test is being done. Most babies cry briefly but aren’t upset for long.
Circumcision
Medical societies like the Canadian Pediatric Society and the American Academy of Pediatrics have advised since the 1970s that routine circumcision of infants be discontinued. Newborn circumcision is no longer done in the hospital. It is not covered by medical insurance and will cost over $100. It is considered cosmetic surgery as there is NO medical reason for circumcising a newborn.
Circumcision carries risks – as any surgical procedure does – including infection, excessive bleeding and scarring. Baby boys are strapped down on a board. Local anesthetic is usually used, but there will be pain (the penis is well supplied with nerves) when the anesthetic wears off.
If you choose to circumcise an infant son for religious or personal reasons, please organize the surgery during your pregnancy.